Risk factors and outcomes of conversion to open surgery in benign gynecological laparoscopies: a case-control study
To describe cases of conversion from gynecological laparoscopy to open surgery, assess risk factors for conversion and conversion outcomes. A retrospective case-control study SETTING: Tertiary referral hospital in Melbourne, Australia PATIENTS: Eighty-five cases of conversion from laparoscopy to lap...
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| Veröffentlicht in: | Journal of minimally invasive gynecology 2021-04 |
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| creator | Richards, Dr Lucy Healey, A/Prof Martin Cheng, Dr Claudia Reddington, Dr Charlotte Robson-Hamond, Dr Caitlin Dior, Dr Uri |
| description | To describe cases of conversion from gynecological laparoscopy to open surgery, assess risk factors for conversion and conversion outcomes.
A retrospective case-control study SETTING: Tertiary referral hospital in Melbourne, Australia PATIENTS: Eighty-five cases of conversion from laparoscopy to laparotomy and 170 controls matched by age, surgical date and gynecological unit from 2006-2017.
Demographic, clinical and surgical data was collected and compared between the study groups. Logistic regression was performed to identify preoperative and intraoperative risk factors for conversion.
Rate of conversion during the study period was 0.7%. The most common indication for conversion was unexpected surgical complexity (67% of cases) which included severe adhesive disease, specimen size, severe pathology and inadequate views. Factors that were significantly associated with risk of conversion in multivariate analysis were previous pelvic inflammatory disease (aOR 5.16 (1.35-19.71 95% CI, p=.02), previous open surgery (aOR 3.62 (1.52-8.58) 95% CI, p |
| doi_str_mv | 10.1016/j.jmig.2021.03.013 |
| format | Article |
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A retrospective case-control study SETTING: Tertiary referral hospital in Melbourne, Australia PATIENTS: Eighty-five cases of conversion from laparoscopy to laparotomy and 170 controls matched by age, surgical date and gynecological unit from 2006-2017.
Demographic, clinical and surgical data was collected and compared between the study groups. Logistic regression was performed to identify preoperative and intraoperative risk factors for conversion.
Rate of conversion during the study period was 0.7%. The most common indication for conversion was unexpected surgical complexity (67% of cases) which included severe adhesive disease, specimen size, severe pathology and inadequate views. Factors that were significantly associated with risk of conversion in multivariate analysis were previous pelvic inflammatory disease (aOR 5.16 (1.35-19.71 95% CI, p=.02), previous open surgery (aOR 3.62 (1.52-8.58) 95% CI, p<.01), history of endometriosis (aOR 2.96 (1.17-7.50 95% CI, p=.02) and elevated body mass index (aOR 1.07 (1.01-1.13) 95% CI, p=0.02). As compared to current surgery for endometriosis, odds of conversion were higher in surgeries for emergency indications (aOR 5.40 (1.53-18.98) 95% CI, p<.01), uterine pathologies (aOR 3.34 (1.10-10.12) 95% CI, p=.03) and adnexal pathologies (aOR 2.76 (1.19-6.40) 95% CI, p=.02). With the inclusion of intraoperative factors, surgical adhesions were also found to be associated with conversion (aOR 3.19 (1.30-7.85) 95% CI, p=.01). Most skilled laparoscopic surgeon level as defined by the Australasian Gynaecological Endoscopy and Surgery Society (AGES) was not associated with conversion risk. Conversion to laparotomy was associated with a higher rate of intra-operative and post-operative complications and prolonged length of stay.
Conversion to laparotomy is a rare but very important clinical outcome measure of laparoscopic surgery. Understanding the factors contributing to conversion and peri-operative outcomes may help clinicians to identify and counsel patients before surgery and to reduce surgical morbidity.</description><identifier>EISSN: 1553-4669</identifier><identifier>DOI: 10.1016/j.jmig.2021.03.013</identifier><identifier>PMID: 33892186</identifier><language>eng</language><publisher>United States</publisher><ispartof>Journal of minimally invasive gynecology, 2021-04</ispartof><rights>Copyright © 2021. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27915,27916</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33892186$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Richards, Dr Lucy</creatorcontrib><creatorcontrib>Healey, A/Prof Martin</creatorcontrib><creatorcontrib>Cheng, Dr Claudia</creatorcontrib><creatorcontrib>Reddington, Dr Charlotte</creatorcontrib><creatorcontrib>Robson-Hamond, Dr Caitlin</creatorcontrib><creatorcontrib>Dior, Dr Uri</creatorcontrib><title>Risk factors and outcomes of conversion to open surgery in benign gynecological laparoscopies: a case-control study</title><title>Journal of minimally invasive gynecology</title><addtitle>J Minim Invasive Gynecol</addtitle><description>To describe cases of conversion from gynecological laparoscopy to open surgery, assess risk factors for conversion and conversion outcomes.
A retrospective case-control study SETTING: Tertiary referral hospital in Melbourne, Australia PATIENTS: Eighty-five cases of conversion from laparoscopy to laparotomy and 170 controls matched by age, surgical date and gynecological unit from 2006-2017.
Demographic, clinical and surgical data was collected and compared between the study groups. Logistic regression was performed to identify preoperative and intraoperative risk factors for conversion.
Rate of conversion during the study period was 0.7%. The most common indication for conversion was unexpected surgical complexity (67% of cases) which included severe adhesive disease, specimen size, severe pathology and inadequate views. Factors that were significantly associated with risk of conversion in multivariate analysis were previous pelvic inflammatory disease (aOR 5.16 (1.35-19.71 95% CI, p=.02), previous open surgery (aOR 3.62 (1.52-8.58) 95% CI, p<.01), history of endometriosis (aOR 2.96 (1.17-7.50 95% CI, p=.02) and elevated body mass index (aOR 1.07 (1.01-1.13) 95% CI, p=0.02). As compared to current surgery for endometriosis, odds of conversion were higher in surgeries for emergency indications (aOR 5.40 (1.53-18.98) 95% CI, p<.01), uterine pathologies (aOR 3.34 (1.10-10.12) 95% CI, p=.03) and adnexal pathologies (aOR 2.76 (1.19-6.40) 95% CI, p=.02). With the inclusion of intraoperative factors, surgical adhesions were also found to be associated with conversion (aOR 3.19 (1.30-7.85) 95% CI, p=.01). Most skilled laparoscopic surgeon level as defined by the Australasian Gynaecological Endoscopy and Surgery Society (AGES) was not associated with conversion risk. Conversion to laparotomy was associated with a higher rate of intra-operative and post-operative complications and prolonged length of stay.
Conversion to laparotomy is a rare but very important clinical outcome measure of laparoscopic surgery. Understanding the factors contributing to conversion and peri-operative outcomes may help clinicians to identify and counsel patients before surgery and to reduce surgical morbidity.</description><issn>1553-4669</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqFjrtOxDAQAC0kxB2PH6BA-wMxdsyZO1oEokb0J5-zsRwcr-V1kPL3UEBNNc1oNELcaiW10vZ-ktMcg-xVr6UyUmlzJrZ6tzPdg7WHjbhknpQyj0rZC7ExZn_o9d5uBb9H_oTR-UaVweUBaGmeZmSgETzlL6wcKUMjoIIZeKkB6woxwwlzDBnCmtFTohC9S5BccZXYU4nIT-DAO8buJ9QqJeC2DOu1OB9dYrz55ZW4e335eH7rynKacTiWGmdX1-PfpflX-AZNIlBy</recordid><startdate>20210420</startdate><enddate>20210420</enddate><creator>Richards, Dr Lucy</creator><creator>Healey, A/Prof Martin</creator><creator>Cheng, Dr Claudia</creator><creator>Reddington, Dr Charlotte</creator><creator>Robson-Hamond, Dr Caitlin</creator><creator>Dior, Dr Uri</creator><scope>NPM</scope></search><sort><creationdate>20210420</creationdate><title>Risk factors and outcomes of conversion to open surgery in benign gynecological laparoscopies: a case-control study</title><author>Richards, Dr Lucy ; Healey, A/Prof Martin ; Cheng, Dr Claudia ; Reddington, Dr Charlotte ; Robson-Hamond, Dr Caitlin ; Dior, Dr Uri</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-pubmed_primary_338921863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Richards, Dr Lucy</creatorcontrib><creatorcontrib>Healey, A/Prof Martin</creatorcontrib><creatorcontrib>Cheng, Dr Claudia</creatorcontrib><creatorcontrib>Reddington, Dr Charlotte</creatorcontrib><creatorcontrib>Robson-Hamond, Dr Caitlin</creatorcontrib><creatorcontrib>Dior, Dr Uri</creatorcontrib><collection>PubMed</collection><jtitle>Journal of minimally invasive gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Richards, Dr Lucy</au><au>Healey, A/Prof Martin</au><au>Cheng, Dr Claudia</au><au>Reddington, Dr Charlotte</au><au>Robson-Hamond, Dr Caitlin</au><au>Dior, Dr Uri</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors and outcomes of conversion to open surgery in benign gynecological laparoscopies: a case-control study</atitle><jtitle>Journal of minimally invasive gynecology</jtitle><addtitle>J Minim Invasive Gynecol</addtitle><date>2021-04-20</date><risdate>2021</risdate><eissn>1553-4669</eissn><abstract>To describe cases of conversion from gynecological laparoscopy to open surgery, assess risk factors for conversion and conversion outcomes.
A retrospective case-control study SETTING: Tertiary referral hospital in Melbourne, Australia PATIENTS: Eighty-five cases of conversion from laparoscopy to laparotomy and 170 controls matched by age, surgical date and gynecological unit from 2006-2017.
Demographic, clinical and surgical data was collected and compared between the study groups. Logistic regression was performed to identify preoperative and intraoperative risk factors for conversion.
Rate of conversion during the study period was 0.7%. The most common indication for conversion was unexpected surgical complexity (67% of cases) which included severe adhesive disease, specimen size, severe pathology and inadequate views. Factors that were significantly associated with risk of conversion in multivariate analysis were previous pelvic inflammatory disease (aOR 5.16 (1.35-19.71 95% CI, p=.02), previous open surgery (aOR 3.62 (1.52-8.58) 95% CI, p<.01), history of endometriosis (aOR 2.96 (1.17-7.50 95% CI, p=.02) and elevated body mass index (aOR 1.07 (1.01-1.13) 95% CI, p=0.02). As compared to current surgery for endometriosis, odds of conversion were higher in surgeries for emergency indications (aOR 5.40 (1.53-18.98) 95% CI, p<.01), uterine pathologies (aOR 3.34 (1.10-10.12) 95% CI, p=.03) and adnexal pathologies (aOR 2.76 (1.19-6.40) 95% CI, p=.02). With the inclusion of intraoperative factors, surgical adhesions were also found to be associated with conversion (aOR 3.19 (1.30-7.85) 95% CI, p=.01). Most skilled laparoscopic surgeon level as defined by the Australasian Gynaecological Endoscopy and Surgery Society (AGES) was not associated with conversion risk. Conversion to laparotomy was associated with a higher rate of intra-operative and post-operative complications and prolonged length of stay.
Conversion to laparotomy is a rare but very important clinical outcome measure of laparoscopic surgery. Understanding the factors contributing to conversion and peri-operative outcomes may help clinicians to identify and counsel patients before surgery and to reduce surgical morbidity.</abstract><cop>United States</cop><pmid>33892186</pmid><doi>10.1016/j.jmig.2021.03.013</doi></addata></record> |
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| issn | 1553-4669 |
| language | eng |
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| source | ScienceDirect Journals (5 years ago - present) |
| title | Risk factors and outcomes of conversion to open surgery in benign gynecological laparoscopies: a case-control study |
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